VASCULAR SURGERY FEMORAL POPILTEAL FEMPOP BYPASS Post op Uses saphenous vein or

Vascular surgery femoral popilteal fempop bypass post

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VASCULAR SURGERYFEMORAL-POPILTEAL(FEMPOP) BYPASSPost-op:Uses saphenous vein or internal mammary arterySternotomy opens chestPlaced on bypass machine; heart is stoppedChest tubes and temporary pacing wires insertedOn vent with a-line, swanz-ganz line for 1st dayVentilator set up, obtain initial blood gasesECG monitorSuction applied to chest drains and NGT if presentWarm patient on arrival (As patient warms, vasodilates, watch BP)Ensure drug/fluid infusions are given according to prescription, labelled correctly and are infusing at correct rateCommence epidural monitoring if patient has a thoracic epidural - every hourCentral lines are secure- Central Line, Arterial Line,· Swan Ganz CatheterAssess surgical sites (chest & legs) (Jackson-pratt/hemovac to legs)Assess every hour airway, breathing, blood gases, fluids, drugs, circulation, bleeding, sedation, pain levels, patient awareness, patient pychological state, wound condition and oral hygiene Hourly output (report UO<30cc. CT>100) May replace CT drainage with bloodPost-op: in ICU 1 day, in hospital 4-5Extubated same day or 1st post op day; reinforce pulmonary toiletSwan-ganz and a-line out after 1 dayManage surgical pain; splint chest for C & DBMonitor incisions sitesGet OOB 1st post-op day; increase activity as toleratedAdvance to cardiac diet once peristalsis resumesChest tube out after 2 daysTemporary pacing wires (covered with non-conducting material to prevent accidental charge) removed day 2Discharge teaching:Similar to post-MI (review NUR105 notes)Cardiac dietCoughing, deep breathing, ISNo lifting (especially on side of internal mammary artery) for 2-3 monthsNo driving 6 weeksReport angina, rapid weight gain (weigh daily), excessive fatigue, palpitations, dizzinessTeach adaptations of wound infectionCardiac rehab to slowly rebuild activity toleranceComplications CABG:Graft leakage: hypotension, large CT drainage—may need surgery; may need protamine sulfate to reverse heparinPost-Pump psychosis: Haldol; get out of ICU; safety measures (restraints, observation, orientation)Cardiac tamponade: distended neck veins, decreased pulse pressure with hypotensioon, tachycardia, muffled heart sounds, anxiety, check CT drainage—may need surgeryDysrhythmias (check K+ and PaO2)Hypovolemia: Volume expanders (FFP) & bloodmay need vasopressors (dopamine, dobutamine, epinephrine, norepinephrine (Levophed), vasopressin (Pitressin), milrinone (Primacor)PE or CVAFever: atelectasis and infectionInterventions: surgical:Angioplasty (with or without stents)Endarterectomy (removal of lining of vessel along with clot & plaque)Bypass graft (may use saphenousvein or artificial material)AmputationWatch for hemorrhage and infectionMonitor peripheral circulationAvoid leg crossing or long periods of standingMinor edema OK Be careful with compression stockings not pressing on graft9
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CARDIOVASCULAR MEDICATIONSDiuretics:loop diuretics –Lasix (furosemide) Bumex(bumetanide)—IV/POtx—fast acting excreting of fluid and electrolytes via kidney
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